Predictive Factors For Failure Research Articles

Embolization of Middle Meningeal Arteries for Symptomatic Subacute Subdural Hematoma in Patients with Cancer

PurposeThe purpose of this study was to evaluate the technical and clinical success of middle meningeal artery (MMA) embolization performed for symptomatic subacute subdural hematoma (SDH) in patients with cancer. MethodsThis study retrospectively included 23 consecutive patients (12 men, 11 women; median age 61 years, interquartile range: 55.5–75.5) who underwent 34 MMA angiograms for symptomatic SDH in 2022 and 2023. Median SDH thickness was 10.5mm (7-12). Median platelet count was 117 K/mcL (54.5–218). Ten patients (43.5%, 10/23) had hematologic malignancies, 7 patients (30.4%, 7/23) had surgery. Fluoroscopy time (FT), reference dose (RD), and kerma area product (Kap) were analyzed. Adverse events and outcomes were recorded. ResultsThe median imaging and clinical follow-up were 65 days (36.5–190.5) and 163 days (86–274), respectively. The technical success rate was 91.2% (31/34) as 3 MMA were not identified in 2 patients. Median procedure duration was 61 min (55.5–75.5). Median FT was 21.6 min (15.5–31.8); median RD was 158 mGy (96–256); and median Kap was 32.9 Gy.cm2 (20.4–45.1). No further intervention was needed. For 16 patients, SDH resolved after in median 59.5 days (50-90). For 7 patients, SDH remained visible on the last imaging follow-up performed at 24 days in median (6.5-36.5). No predictive factor of failure was identified. The adverse event rate was 1/23 (4.3%). Eight patients (34.8%, 8/23) died during follow-up from progression of cancer. ConclusionsMMA embolization of symptomatic SDH in patients with cancer appears safe and is associated with improvement in clinical symptoms.

Office endometrial sampling: effectiveness and predictive factors of success in Novak versus Endosampler devices.

The study aimed to evaluate the rate of endometrial sampling (ES) failure, predictive factors of success, and reliability as diagnostic methods of Endosampler versus Novak. A retrospective single-center study was carried out with all patients who underwent ES via Endosampler or Novak in 2020 and 2021. Demographic data, personal background, and histopathologic results were evaluated. Eighty-six patients underwent ES by Novak and 90 by Endosampler. The failure rate of ES was 43.2% with lower values for Endosampler (33.3% vs. 53.5%, P<0.05). Age, biopsy device, menopausal status, indication for biopsy, and amount of sample collected were predictive factors of failure. Analyzing each device, Endosampler was only affected by menopausal status. Only 50% in Novak and 62.5% in the Endosampler group of endometrial neoplasia cases were detected by these methods. Analyzing the performance for endometrial neoplasia (EN), we obtained higher values of sensitivity and accuracy for Endosampler (62.5% vs. 50.0% and 83.3% vs. 72.7%), respectively. In our study, the failure rate obtained was in line with other previous studies. Menopausal status, age, type of biopsy device, indication for biopsy, and amount of sample collected affected ES performance. Analyzing diagnostic performance for EN, we found that these methods have better reliability for positive results than for negative ones, which may indicate the need for further evaluation in cases of high clinical suspicion. In short, we obtain a higher rate of success rate in Endosampler devices and better performance in diagnosing EN, which is the major objective of an ES.

Predictive factors of sentinel lymph node failed mapping in endometrial carcinoma patients: a systematic review and meta-analysis

ObjectiveIn endometrial carcinoma patients, sentinel lymph node bilateral mapping fails in 20–25% of cases, with several factors affecting the likelihood of detection. However, pooled data about predictive factors of failure...

Factors Predicting Avascular Necrosis After Closed Reduction and Internal Fixation of Displaced Subcapital Fractures of the Hip

Background: The main complications following closed reduction and internal fixation of displaced intracapsular femur fractures (DICFF) are avascular necrosis (AVN) and nonunion. Little is known about the factors that predict these complications. The purpose of this study was to assess the clinical and radiological risk factors of failure following closed reduction and internal fixation of DICFF among non-elderly patients. Methods: We retrospectively reviewed patients under the age of 65 years who underwent closed reduction and internal fixation of DICFF in our center from January 2007 to January 2018. The extracted data included baseline characteristics and the fixation method. Postoperative radiographs were obtained during follow-up visits in order to evaluate complications, such as AVN and nonunion. Results: In total, 90 patients were included in the study, with a mean follow-up of 6.5 years. Garden III fractures were associated with significantly lower rates of AVN (odds ratio [OR] = 0.304, 95%confidence interval [CI]: 0.101-0.916) compared to Garden IV fractures. Neutral and varus reduction positions had significantly higher rates of AVN (OR = 7.182, 95%CI: 1.951- 26.446) and (OR= 5.560, 95%CI: 1.130-27.351), respectively, compared to the valgus position. Longer surgery procedures were associated with a higher risk of AVN (OR = 1.018, 95%CI: 1.006-1.031). Conclusions: Both varus and neutral reduction positions as well as Garden IV classification served as predictive factors for failure following closed reduction and internal fixation of DICFF. The type of fixation (CCS vs Targon plate) and the Pauwel angle had no significant effect on the rates of AVN or nonunion following fracture reduction.

Predictive factors for treatment failure in reducing alcoholic consumption by case management in alcoholics living in permanent rental apartments

IntroductionBased on the results showing that there are more alcoholics in the low-income bracket, case management (CM) for such cases was initiated in 2011. As a result, the treatment failure rate was identified between 43-44% based on the WHO criteria.ObjectivesWe investigated the predictive factors for the treatment failure to maximize successful CM treatment.MethodsThirty-nine subjects from Sasang-gu and Saha-gu treated by four social workers using CM were included in this study. Failure was defined when the level of risk was maintained or increased as per the WHO criteria. The clinical characteristics of the subjects including their age and gender were collected.ResultsTypically, 17 (43.6%) subjects demonstrated treatment failure by the CM (TF). Compared with the subjects who were treated successfully (n=22; TS), TF maintained abstinence in shorter periods in terms of the longest abstinent period compared with TS while CM (28.24±.99 vs. 76.82±.27, p=.025). The higher population in TF did not make an effort to quit drinking compared with TS while CM (41.2% vs.13.6%, p=.051). Also, more TF stayed with their family members compared with TS (58.8% vs. 31.8%, p=.092).ConclusionsThe results showed that shorter abstinence periods and the absence of efforts initiated to quit drinking while CM, and living with family members were the predictive factors for failure in treating alcoholics by the CM. It is presumed that influencing patients to quit drinking and encouraging them to abstain for longer periods are crucial to attaining successful treatment.DisclosureNo significant relationships.

Non-Valvular Atrial Fibrillation Cardioversion: Experience of the Cardiology department of Mohammed V Military Teaching Hospital

anticoagulation therapy would be the removal of this arrhythmia and any future recurrence, a goal often difficult to achieve.The aim of this work is to evaluate the efficacy of atrial fibrillation cardioversion as well as the success predictive factors of sinus rhythm maintenance at one year following a successful cardioversion. Materials and methods: 50 patients with non-valvular atrial fibrillation underwent cardioversion: 70% by electrical shock and 30% by pharmacological means, the clinical characteristics of the patients the results of cardioversion and follow-up were collected and analyzed. Results: The average age of our patients was 53 years with a sex ratio of 2. 30% of patients had hypertensive heart disease, 8% ischemic heart disease, 8% dilated cardiomyopathy and the rest had no underlying heart disease. The average diameter of the left atrium was 41 mm and the average surface area was 20 cm². Primary success rate of cardioversion was 82% with better efficacy of electric shock compared to pharmacological cardioversion. The maintenance rate of sinus rhythm at 1 year was 70%. Predictive factors of failure and / or recurrence at 1 year were old atrial fibrillation and significant dilation of the left atrium. Conclusion: This study confirms the interest of atrial fibrillation cardioversion and underlines the importance of preliminary selection of the patients, such a selection must be made on the basis of the predictive factors of success usually recognized in the literature.

QUELS SONT LES FACTEURS PREDICTIFS DECHEC DU TRAITEMENT ENDOSCOPIQUE DES ULCERES HEMORRAGIQUES?

Ulcerative gastrointestinal bleeding is the most frequent emergency in digestive endoscopy. Management is based on the initiation of an infusion of proton pump inhibitors as soon as the diagnosis is mentioned. Upper endoscopy should be performed as quickly as possible under the best technical conditions. Two combined techniques of endoscopic hemostasis, most often by injection of reduced adrenaline and placement of clips, allow hemostasis in most situations. In case of failure, a new endoscopy can be proposed. Surgery and interventional radiology have a place in second or even third line treatment. A retrospective study was carried out on 80 patients over an extended period from 2009 to 2019. Including all patients presented to the emergency department for upper gastrointestinal bleeding regardless of the mode of exteriorization and who were reinforced with endoscopic treatment. risk of surgery and death. The objective of our work is to evaluate the effectiveness of endoscopic management and to deduce the predictive factors of failure of endoscopic hemostasis.

Locally developed external fixators as definitive treatment of open tibia diaphyseal fractures: a clinical prospective study conducted in Ivory Coast.

This study sought to evaluate the effectiveness of locally developed external fixators (LDEF) as definitive treatment for open tibia diaphyseal fractures (OTDF) in Ivory Coast. Gustilo I, II, and IIIA OTDFs of patients admitted within 24hours of injury were prospectively included and treated with LDEF. The rates of union, mal-union, septic complications, as well as the functional results were assessed, in addition to the LDEF construct's integrity. Predictive factors of failure or poor results were assessed. Overall, 40 OTDF patients were admitted within 24hours of injury. Gustilo I, II, and IIIA fractures were observed in three, 13, and 24 patients, respectively. Uneventful fracture healing was obtained in 29 cases, with an average union time of 8.47months. Mal-union and non-union were registered in three and four cases, respectively. Pin-track infection (PTI) was observed in 13 cases and deep infection in seven. Infection resolved in all patients except four, who developed chronic osteomyelitis. None of the non-unions were associated with an infection. The overall functional result was satisfactory in 32 patients. PTI was the only predictive factor for chronic infection. Biplanar frames, when compared to monoplanar constructs, were associated with a significantly improved functional outcome. LDEF improved significantly the OTDF management, as it provided better stability and superior fracture healing rates than what is observed with the standard of care in the same environment. PTI remains an essential problem but with, hopefully, limited negative consequences.

Clinical outcomes and predictive factors for failure with MPFL reconstruction combined with tibial tubercle osteotomy and lateral retinacular release for recurrent patellar instability

BackgroundMedial patellofemoral ligament (MPFL) reconstruction combined with tibial tubercle osteotomy (TTO) and lateral retinacular release (LRR) is one of the main treatment methods for patellar instability. So far, few studies have evaluated the clinical effectiveness and assessed potential risk factors for recurrent patellar instability.PurposeTo report the clinical outcomes of MPFL reconstruction combined with TTO and LRR at least three years after operation and to identify potential risk factors for recurrent patellar instability.MethodsA retrospective analysis of medical records for patients treated with MPFL, TTO and LRR from 2013 to 2017 was performed. Preoperative assessment for imaging examination included trochlear dysplasia according to Dejour classification, patella alta with the Caton-Deschamps index (CDI), tibial tubercle–trochlear groove distance. Postoperative assessment for knee function included Kujala, IKDC and Tegner scores. Failure rate which was defined by a postoperative dislocation was also reported.ResultsA total of 108 knees in 98 patients were included in the study. The mean age at operation was 19.2 ± 6.1 years (range, 13–40 years), and the mean follow-up was 61.3 ± 15.4 months (range, 36–92 months). All patients included had trochlear dysplasia (A, 24%; B, 17%; C, 35%; D, 24%), and 67% had patellar alta. The mean postoperative scores of Tegner, Kujala and IKDC were 5.3 ± 1.3 (2–8), 90.5 ± 15.5 (24–100) and 72.7 ± 12.1 (26–86). Postoperative dislocation happened in 6 patients (5.6%). Female gender was a risk factor for lower IKDC (70.7 vs 78.1, P = 0.006), Tegner (5.1 vs 6.0, P = 0.006) and Kujala (88.2 vs 96.6, P = 0.008). Age (p = 0.011) and trochlear dysplasia (p = 0.016) were considered to be two failure factors for MPFL combined with TTO and LRR.ConclusionAs a surgical method, MPFL combined with TTO and LRR would be a reliable choice with a low failure rate (5.6%). Female gender was a risk factor for worse postoperative outcomes. Preoperative failure risk factors in this study were age and trochlear dysplasia.Level of EvidenceLevel IV; Case series

Epiphyseal fragment as a predictive factor of failure in fixation of proximal fractures of the humerus

IntroductionFractures of the proximal humerus are frequent and are widely studied with regards to their treatment indications. The aim of this article is to establish a correlation between the size of the epiphyseal fragment in fractures of the proximal humerus and the probability of loss of reduction after a surgical procedure. MethodsA total of 47 surgically treated proximal humeral fractures were reviewed. Preoperative CT scans were used to evaluate the size of the epiphyseal fragment of the fracture. Postoperative X-rays were analyzed to assess complications, especially loss of reductions. Mean age was 61 years old (29–91 years). ResultsIn total, 42 shoulders were evaluated. The average size of the epiphyseal fragment was 38.3 mm (32–50 mm) the largest longitudinal length; and 19.9 mm (12–30 mm) the largest cross-sectional length. The most frequent complication observed was loss of reduction. The statistical analysis showed significance that patients with smaller cross-sectional size of the epiphyseal fragment presented more complications (p = 0.034), and based on the graph and ROC curve, a value of 15.5 mm was considered as the cutoff value for failure. ConclusionA cross-sectional length of the epiphyseal fragment of less than 15.5 mm indicates a higher probability of loss of reduction in fractures of the proximal end of the humerus after extra-medullary osteosynthesis.

Treatment of anal fistula with FiLaC®: results of a 10-year experience with 175 patients.

Treatment of fistula-in-ano with fistula laser closure (FiLaC®) is a sphincter-saving procedure indicated for patients with complex anal fistulas. The aim of our study was to evaluate the clinical results of a 10-year experience with FiLaC®. Data from patients with cryptoglandular anal fistula who underwent laser closure with FiLaC® in June 2009-May 2019 were evaluated. The primary study endpoint was healing rate. Secondary endpoints were evaluation of morbidity and assessment of possible predictive factors of failure. Out of a total of 180 patients, 5 had been lost to follow-up. 175 patients [m:f: 115:60; median age 49years (range18-81years)] with cryptoglandular fistulas treated with FiLaC® were included in the study. Fistulas were transphincteric in 152 (86.8%) cases, intersphincteric in 18 (10.3%), and suprasphincteric in 5 (2.9%). A seton or draining silicon loop was placed in 142 (81.8%) patients at a median of 14weeks (range10-28weeks) prior to FiLaC®. At median follow-up of 60months (range 9-120months), the overall primary healing rate was 66.8% (117/175). Thirty-eight patients (21.7%) failed to heal. Twenty out of 175 (11.4%) patients had recurrence at median follow-up of 18months (range 9-50months). Patients in whom a seton/loop was inserted for drainage at the first-stage procedure had a statistically significant higher rate of success (100/142, 70.4% vs. 17/33, 51.5%, respectively; p 0.0377; odds ratio 0.45). Forty-eight patients were reoperated on at a median of 15months (range 12-20months) after laser treatment. Twenty-six underwent redo laser closure with FiLaC®, and 12 of them healed (46%), for a secondary success rate of 73.7%. Longer follow-up confirms the efficacy of FiLaC® in the treatment of complex anal fistulas. Its use and implementation should be encouraged.

Combined Phacoemulsification and Ex-PRESS Implant with Everting Suture in Primary Angle-Closure Glaucoma: Survival Analysis and Predictive Factors.

The purpose of this study was to evaluate the efficacy and safety of combined phacoemulsification and Ex-PRESS implant with everting suture in primary angle-closure glaucoma (PACG) and to examine predictive factors of failure. Twenty-three eyes of 18 patients were enrolled. Data about time of removal of releasable sutures and traction of the everting suture and about changes in intraocular pressure (IOP) were collected, as well as comprehensive ophthalmic examinations. Success was defined by the following criteria: IOP ≤ 18 mmHg (criterion 1); IOP ≤ 15 mmHg (criterion 2); and IOP ≤ 12 mmHg (criterion 3). Success was categorized as complete or qualified, depending on whether it was reached without or with drugs, respectively. Success rate was assessed with Kaplan–Meier survival analysis with a Cox proportional hazard model to adjust for potential confounders. The lowering of IOP and the reduction of medications were statistically significant at every follow-up visit compared with the baseline (p < 0.05). The complete success rates were 87%, 70%, and 17% accordingly to criterion 1, 2, and 3; the qualified success rates were 93%, 70%, and 20%, respectively. Most of the complications resolved spontaneously and conservatively. In conclusion, combined phacoemulsification and Ex-PRESS Minishunt implant with everting suture is a safe and effective surgery, even in PACG, lowering IOP and number of medications.

Predictive factors for failure of the levonorgestrel releasing intrauterine system in women with heavy menstrual bleeding

BackgroundThis study was conducted to identify factors that are associated with failure of treatment using the levonorgestrel releasing intrauterine system (LNG-IUS) in women with heavy menstrual bleeding.MethodsFor this study, data of a cohort of women treated with an LNG-IUS was used. Women who suffered from heavy menstrual bleeding, aged 34 years and older, without intracavitary pathology and without a future child wish, were recruited in hospitals and general practices in the Netherlands. Eight potential prognostic baseline variables (age, body mass index, caesarean section, vaginal delivery, previous treatment, anticoagulant use, dysmenorrhea, and pictorial blood assessment score) were analyzed using univariable and multivariable regression models to estimate the risk of failure. The main outcome measure was discontinuation of the LNG-IUS within 24 months of follow up, defined as removal of the LNG-IUS or receiving an additional intervention.ResultsA total of 209 women received the LNG-IUS, 201 women were included in the analyses. 93 women (46%) discontinued LNG-IUS treatment within 24 months. Multivariable analysis showed younger age (age below 45) (adjusted RR 1.51, 95% CI 1.10–2.09, p = .012) and severe dysmenorrhea (adjusted RR 1.36, 95% CI 1.01–1.82, p = .041) to be associated with a higher risk of discontinuation.ConclusionsHigh discontinuation rates are found in women who receive an LNG-IUS to treat heavy menstrual bleeding. A younger age and severe dysmenorrhea are found to be risk factors for discontinuation of LNG-IUS treatment. These results are relevant for counselling women with heavy menstrual bleeding.

Risk factors affecting failure of colonoscopic detorsion for sigmoid colon volvulus: a single center experience.

Colonoscopic detorsion (CD) is the first treatment option for uncomplicated sigmoid volvulus (SV). We aim to examine the factors affecting the failure of CD. The files of patients, treated after diagnosis of SV between January 2015 and September 2020, were retrospectively reviewed. Patients' demographic data, comorbidities, endoscopy reports, and surgical and other treatments were recorded. Patients were divided into two groups, as the successful CD group and unsuccessful CD group. The data were compared between the groups, and multivariate analysis of statistically significant variables was performed. There were 21 patients in the unsuccessful CD group and 52 patients in the successful CD group. The unsuccessful CD rate was found to be 28.76%; this is likely a function of more neuropsychiatric disease, more accompanying sigmoid diverticulum, previous abdominal surgery, abdominal tenderness, onset of symptoms for more than 48 h, higher mean intra-abdominal pressure (IAP), IAP over 15 mmHg, larger mean diameter of the cecum, the cecum diameter over 10 cm, and higher mean C-reactive protein (CRP) values as statistically significant. In the multivariate analysis, previous abdominal surgery and cecum diameter over 10 cm were seen as predictive factors for failure of CD (p=0.049, OR=0.103, and p = 0.028, OR=10.540, respectively). CD failure rate was significantly associated with previous abdominal surgery and a cecum diameter over 10 cm. We found that patients with these factors will tend to need more emergency surgery.

Revision of Mason's procedure (vertical banded gastroplasty) to Roux-en-Y gastric bypass: role of an associated fundectomy in weight loss outcomes.

Vertical banded gastroplasty (VBG) presents a significant rate of long-term complications, and revisions are often necessary. Conversion to Roux-en-Y gastric bypass (RYGB) seems to be preferred, but literature data remain limited. To analyze the indications, safety, results of conversions from VBG to RYGB, and to identify predictive factors of success or failure. Two specialized centers of bariatric surgery. This bicentric retrospective study included all the patients who benefited from a conversion from VBG to RYGB between 2008 and January 2020. Demographic characteristics, indications, preoperative workups, intraoperative data, complications, and weight loss results were analyzed. During the study period, 85 patients underwent a conversion to RYGB. The mean body mass index (BMI_ before conversion was 40.6 kg/m2. 82.3% of the patients were converted because of weight loss failure and 17.6% because of a complication of their VBG. The global rate of complications was 25%. After an average follow-up of 35 months and a rate of loss to follow-up of 33%, the mean BMI was 33.5 kg/m. The weight loss success rate according to Reinhold's criteria was 64.7%, and resolution of complications was obtained in 89.1%. The association of a fundectomy was a predictive factor of weight loss (odds ratio, .27; P = .04), whereas primary failure of the VBG was a predictive factor of failure. Conversion from VBG to RYGB remains the procedure of choice to achieve satisfying weight loss and resolution of functional complications. The addition of a fundectomy appeared to have a significant positive impact on weight loss outcomes.

Patterns Of Failure For Adolescent And Young Adult Hodgkin Lymphoma Patients Treated With Radiotherapy In The Modern Era: A Multi-Institution Review

The treatment of adolescent and young adults (AYA) with classical Hodgkin lymphoma (cHL) can be challenging given the significant differences in treatment approaches for the pediatric and adult populations. We aimed to assess outcomes in this population across three institutions to evaluate patterns of and predictive factors for failure following treatment including radiotherapy. After institutional review board approval at all institutions, we included 91 consecutive patients with stage I or II cHL treated with radiotherapy as part of their initial course of treatment at one of three institutions between July 2008 and December 2017. We excluded patients with less than 3 months of follow-up. Demographic and treatment variables were abstracted from patient medical records. In- versus out-of-field relapses were determined at the discretion of the treating physician. Kaplan-Meier survival analyses were performed to determine differences in disease-free survival (DFS) and overall survival (OS). We included 91 patients; the cohort was predominately female (64%) and had a relatively even age distribution (<18: 26%; 18 - <30: 37%; ≥30: 36%); most patients had stage II disease (87%). The majority of patients were treated with typical adult doses in excess of 30 Gy (59%). Total dose ranged from 15 - 45 Gy. A total of 63% of patients had unfavorable-risk disease. There was an even balance by treatment modality with 53% of patients receiving proton therapy and the remainder receiving photon therapy. With a median follow-up of 2.6 years, the overall 2-year progression-free survival rate (PFS) was 89%. Of the 12 patients who experienced progression after RT, 4 occurred out-of-field only, 2 occurred in-field only, and 6 experienced progression both in- and out-of-field. There were no significant differences in 2-year PFS among AYA patients by radiotherapy dose received (≥30 Gy, 91%; <30 Gy, 86%; p = 0.82). Likewise, there was no difference in 2-year PFS among patients who received either proton or photon therapy (proton, 94%; photon, 83%; p = 0.07). Patients with favorable- and unfavorable-risk disease had similar outcomes (2-year DFS 94% vs 86%, p = 0.27). AYA patients with early-stage cHL experience excellent outcomes after treatment regimens including radiotherapy regardless of dose used. Proton therapy appears to be associated with no reduction in disease control relative to photon therapy in this population. Further research in optimally delineating patients who best tolerate lower radiotherapy doses and require more advanced modalities such as proton therapy is needed.

Efficacy of Combined Suprachoroidal Stent and Cataract Surgery in Patients With Glaucoma.

The purpose of this study was to evaluate the efficacy of intraocular pressure (IOP) control after combined CyPass Micro-Stent implantation and cataract surgery (combined surgery). All cases of combined surgery performed from February 2017 to July 2018 at Stein and Doheny Eye Institutes were reviewed. The primary outcome was a qualified success with stratified IOP targets based on criteria: final IOP (A) ≤18 mm Hg and reduction of 20%, (B) ≤15 mm Hg and reduction of 25%, (C) ≤12 mm Hg and reduction of 30%. Secondary outcome measures included postoperative IOP and number of medications, complications, additional glaucoma surgery, and postoperative refractive error. Predictive factors for failure were investigated. IOP spike was defined as a postoperative IOP ≥30 or >10 mm Hg increase from preoperative IOP. One hundred forty-one eyes (107 patients) were included. Mean (±SD) preoperative IOP was 15.4±3.4 mm Hg on an average of 2.2±1.1 medications. A statistically significant reduction in IOP and number of medications was seen at 12 months (13.8±4.2 mm Hg, 1.3±1.3 medications, P<0.001). Fifteen eyes (10.6%) had a postoperative IOP spike. Thirteen eyes (9.2%) experienced 17 complications (12.1%). Additional glaucoma surgery was performed in 3 eyes (2 patients). Cumulative success rates at 1 year based on criteria A, B, and C were 42%, 33%, and 28%, respectively. Lower preoperative IOP, greater preoperative medication number, the occurrence of postoperative IOP spike, and non-Caucasian ethnicity were associated with failure. Combined CyPass Micro-Stent implantation and cataract surgery may reduce glaucoma medication burden with a success rate of 28% to 42% at 1 year.

Hemorrhoid laser procedure with suture-pexy (HeLPexx): a novel effective procedure to treat hemorrhoidal disease

The hemorrhoid laser procedure with suture-pexy (HeLPexx), consisting of Doppler-guided hemorrhoidal dearterialization with laser and the addition of anal mucopexy, is a novel non-excisional procedure to treat hemorrhoids. The aim of the present study was to describe the technique and report the clinical and long-term results. A prospective study was conducted on patients with grade III hemorrhoids who had HeLPexx from January 2012 to February 2018. Pre- and postoperative assessment included a thorough clinical examination, constipation and incontinence scoring systems and a symptom questionnaire which was administered at all patients before surgery and at each follow-up visit to evaluate bleeding, prolapse, manual reduction, discomfort or pain, and impact on quality of life. Each symptom had a score between 0 and 4, (0 indicates no symptoms and 4 indicates daily symptoms). The sum of the score for each symptom constituted the Hemorrhoid Symptom Score. Resolution of symptoms, pain, morbidity, need for further medical and/or surgical therapy were also recorded. One hundred and seventy consecutive patients with grade III hemorrhoids [74 females; mean age 49.5years (range 22-79) years] were included. Median length of follow-up was 36 (range 12-72) months. Postoperative morbidity included urinary retention (7 patients, 4.1%), bleeding not requiring transfusion (1 patient, 0.6%) and thrombosis of hemorrhoidal piles (2 patients, 1.2%). The mean postoperative pain VAS score at 1week postoperatively was 1.8±1.1 (range 0-5) and 12 (7%) patients used pain medications for more than 1week postoperatively while none of the patients reported any pain by the end of the third week postoperatively. The Hemorrhoid Symptom Score significantly improved from 15.83±3.04 to 1.3±2.4 (p≤0.001) and showed a statistically significant improvement in all items. Recurrent symptoms were reported in 12 patients (7%) who required further treatment. Severe chronic constipation prior to surgery was found to be a predictive factor of failure (p = 0.04). HeLPexx appears to be safe and effective for treatment of symptomatic hemorrhoids. Further studies are needed to confirm our results.

Predictive Factors of Graduation Delay in a Medical Program: a Retrospective Cohort Study in Brazil, 2010-2016

Abstract: Introduction: Medical training is a long and expensive process. Admission processes are highly competitive all over the world but being accepted is no guarantee of academic success. Medical school is demanding and stressful, and some students are not able to cope with this new scenario successfully. It is estimated that 10-15% of medical students experience difficulties in adapting to the course, which can lead to academic failure. The identification of predictive factors of failure supports the creation of mechanisms and strategies to avoid course dropout or graduation delay. To identify predictive factors of academic failure in a Brazilian medical program. Methods: A retrospective observational study was carried out with all medical students admitted to a private Brazilian medical school in 2010 and 2011. The main outcome was academic success. Academic failure was defined as graduation delay or course dropout (Group 1), and academic success was defined as graduating within 6 years (Group 2). Sociodemographic and academic data were collected, including grades obtained at the admission process and the first-semester courses. Freshman students and students with passing grades in the first semester (passed students) were analyzed separately. Descriptive and comparative analyses, logistic regression and ROC curve analysis were performed. The level of significance was 0.05. Results: A total of 312 students were admitted during the study period, but 10 were excluded due to lack of information. Of the 302 students included in the study, 105 were included in Group 1 and 197 were included in Group 2. Thirty-two students failed the first semester. The 270 students with passing grades in the first semester were divided into Group 1 (n=73) and Group 2 (n=197). Among the freshman students, lower admission grades were associated with a higher chance of failure (padjusted=0.012). Of the 270 students with passing grades, low academic performance (courses’ mean grades) was associated with graduation delay (padjusted&lt;0.001). Conclusions: Low grades at the admission process (freshman students) and low academic performance in the first semester (students with passing grades) were predictive factors of academic failure.

High flow nasal cannula in patients treated inside and outside the pediatric intensive care units: pending challenges

High Flow Nasal Cannula (HFNC) is a non-invasive oxygen therapy system it consists in the administration of gas flows, mixture of air and oxygen (O2 ), which exceed the patient’s ventilatory demands and also it is a friendly system, which allows its use outside of critical units. Objective: To collect and analyse the available literature in relation to the definition and clinical parameters that predict the failure of HFNC therapy, in hospitalized pediatric patients inside and outside the ICU, in order to provide knowledge to clinicians to optimize the management of this device, facilitate the administration of the resources and finally, improve the pediatric patients outcomes by identifying the clinical predictors of HFNC failure. Conclusion: There is no consensus regarding the definition of failure of HFNC, which makes it difficult to interpretate the results of the studies and, therefore, its translation into clinical practice. On the other hand, although predictive factors of failure have been identified, in most studies, are restricted to demographic characteristics, comorbidities, severity indexes and/or require the taking of arterial blood tests, therefore their applicability outside of the Pediatric Intensive Care Unit (PICU), is limited. Regarding the identification of clinical parameters, some of the studies mentioned their correlation with failure, but during the administration of the therapy and not previously. This situation makes the early characterization of patients who require HFNC more difficult, and therefore, the individualized decisions that could eventually improve economical and clinical outcomes of our pediatric patients.